Testicular Survival Rate Research Articles

Open Versus Laparoscopic Gubernaculum-Sparing Second-Stage Fowler-Stephens Orchiopexy for Intra-Abdominal Testis: A Long-Term Study.

Background:The benefits of performing open versus laparoscopic gubernaculum-sparing second-stage Fowler–Stephens orchiopexy (FSO) remain unclear. We compared the two techniques to answer this question.Methods:We retrospectively studied a cohort of patients who underwent laparoscopic first-stage FSO and open versus laparoscopic gubernaculum-sparing second-stage FSO at our institution between September 2004 and June 2020 (all patients underwent surgery by a single surgeon). We evaluated both procedures based on the incidence of testicular atrophy, testicular ascent, and other complications.Results:The age at initial surgery was 45.7 ± 28.2 months (median, 39). One hundred nine cases were treated with open second-stage gubernaculum-sparing FSO (OFSO), and 96 cases were treated with laparoscopic second-stage gubernaculum-sparing FSO (LFSO). The mean follow-up period was 59.8 months (median, 54; standard deviation, +35). The overall testicular atrophy rate was 1.5%. Atrophy was observed in 2 and 1 patient in the OFSO and LFSO groups, respectively (1.8% versus 1.0%, P > .05). There was no significant difference in the incidence of testicular ascent between both groups (2.8% versus 3.1%). Five and four complications were noted in the OFSO and LFSO groups, respectively (P > .05).Conclusions:Second-stage gubernaculum-sparing FSO achieved high testicular survival rates and satisfactory testicular positions. Neither the open nor laparoscopic approach appeared superior, because the overall testicular survival rates and incidence of testicular ascent and other complications were equivalent between both groups.

Management of testicular torsion

ObjectiveThis study aimed to summarize clinical manifestations, and physical examination, laboratory examination, and ultrasound results of children with testicular torsion <360°.MethodsWe performed a retrospective study of children who were diagnosed with testicular torsion <360° between October 2007 and October 2017.ResultsThere were 11 (19.2%) patients with testicular torsion of 90°, 33 (58.0%) with 180°, and 13 (22.8%) with 270°. The median age of onset was 5.7 years (range, 1–14 years) and the median duration of symptoms was 4.2 days (range, 0.5–5 days). Ultrasound showed low blood flow in 46 (80.8%) patients. The testis was retained in 41 (72.0%) patients and resected in 16 (28.0%). The testes appeared necrotic at 2 to 3 days after onset for patients with 270° torsion, appeared necrotic at 3 to 4 days after onset for those with 180° torsion, and were not necrotic at 4 to 5 days after onset for those with 90° torsion. The duration of symptoms in children decreased as the torsion angle increased.ConclusionChildren with testicular torsion <360° are relatively young, while the duration of symptoms is relatively long. A high postoperative testicular survival rate is one of the clinical features in this study.

Laparoscopic Orchiopexy for the Nonpalpable Testis : 3 Years Experience

We evaluated the safety and efficacy of laparoscopic orchiopexy to manage a nonpalpable intra-abdominal testis and studied the outcomes. We report our 3 years experience.Patients and methods Laparoscopic Orchiopexy was performed on 28 children (32 testicular units) for non-palpable intra-abdominal testis between 2010 and 2012. We retrospectively reviewed the medical records. The mean age was 3.4 years (range, 2.5 -11 years). Of the 28 patients, 18 (64.28 %) were on the right, 6 (21.44%) were on the left and 4 (14.28%) of bilateral. The mean follow-up period was 14.8 months (range, 3-36 months). Testicular viability and orchiopexed positioning were evaluated within 1 month and beyond 3 months.Results Thirty one testes were descended successfully by laparoscopy. The average operative time was 41.5 ± 3.8 min. Primary laparoscopic orchiopexy done in 26 testes.Three of unilateral and 2 of bilateral testicular units underwent one -stage Fowler-Stephens Orchiopexy. One patient needs laparoscopic orchiectomy. At follow-up (mean 14.8 months), one testis atrophied and need orchiectomy. Testicular survival rate was 96.77% (30/31) and all of the testes maintained an adequate size. Twenty six (86.66%) are in an acceptable scrotal position and 4 testes (13.33%) are mid to high in the scrotum without atrophy. There was no recurrent inguinal hernia.Conclusions Laparoscopic orchiopexy is successful for a nonpalpable intra-abdominal testis with a high testicular survival rate. The low incidence of complications and high success rate underscore the feasibility of this procedure. It is our procedure of choice for the treatment of nonpalpable testis.TAJ 2011; 24(2): 70-75

Laparoscopic one-stage Fowler-Stephens orchiopexy preserving gubernaculum.

To assess gubernaculum-sparing laparoscopic one-stage Fowler-Stephens orchiopexy (FSO), in the management of high intrapelvic testis. Medical reports of boys who underwent laparoscopic one-stage FSO were retrospectively reviewed. High intrapelvic testis was defined as testis ≥3 cm away from ipsilateral internal ring. Testes were evaluated on physical examination at 3rd, 6th and 18th months after surgery. Children were evaluated as for their demographic data, operative findings, interventional details and outcomes. Seven patients met inclusion criteria of the study. Six of 7 testis were small and had abnormal appearance, compared with the contralateral testis. Average distance of the testes from the internal ring was 4.2±1.1 cm (3 to 6). Average age at surgery was 6.1±4.2 years (2 to 12). Average follow-up period was 14±5.8 months (8 to 20), and 5 testis (71.4%) were considered to be normal in volume and scrotal location. Two testes were relatively atrophic and underwent orchiectomy. Our preliminary results shows a good testicular survival rate for one-stage laparoscopic FSO. Sparing collateral vasculature of the gubernaculum is important.

Standardized process to improve patient flow from the Emergency Room to the Operating Room for pediatric patients with testicular torsion

Testicular torsion (TT) remains one of the most common urological emergencies. The length of time from onset of symptoms to detorsion and degree of spermatic cord twisting are usually the most important factors for testicular damage. Therefore early presentation, accurate diagnosis, and prompt treatment are important factors for optimizing the testicular salvage rate. While delay in seeking medical attention is a common cause of testicular loss in pediatric patients with testicular torsion, delays in diagnosis and treatment can be preventable causes of testicular loss. In this study, we aimed to develop a standardized process to improve the patient flow from the Emergency Room (ER) to Operating Room (OR) for TT patients in an academic children's hospital. Thirty consecutive pediatric patients with acute testicular torsion between November 2013 and July 2014 served as the control group. A scrotal pain checklist was implemented in July 2014, and 30 consecutive patients from July 2014 until April 2015 served as the study group. Perioperative parameters including times, ultrasound (US) findings, and surgical results were reviewed. The mean ages of the control group and the study group were similar (12.3±4.9 years and 11.5±5 years, respectively) (p=0.575). ER arrival to OR time, triage completion to OR time, and scrotal US to OR time were significantly decreased in the study group (p<0.001) (Table). Although triage time and ER arrival to scrotal US times were decreased in the study group, the differences were not significant (p=0.071, p=0.112, respectively). Utilizing scoring tools during the triage of patients with scrotal pain can help identify high-risk patients earlier and prevent unnecessary use of resources in an ER serving a large pediatric population. Limitations of this pilot study include the limited number of patients and the potential for the Hawthorne effect (staff awareness of the study). Additionally, we did not examine scrotal pain checklist scores for other acute scrotal diseases. This study focused on a quality improvement process for TT patients, in order to reduce ER to OR times. A standardized process with use of a scrotal pain checklist and prompt communication between the ER, Urology, and Radiology teams led to significantly reduced times from the ER to the OR. Standardized processes for pediatric patients with testicular torsion may help to improve testicular survival rates.

The combined application of low molecular dextran, papaverine and low molecular weight heparin sodium to improve testicle survival rate after the reduction of testicular torsion in rabbits

Objective To observe the effect of drug combinations on the blood flow after reduction of the testicular torsion in rabbits. Methods From October 2014 to June 2015, 36 male rabbits(weighing 1.8-2.4 kg, 10-14 months of age) were randomly divided into experimental group and control group, 18 in each group.Produced by surgical testicular torsion model (720°counterclockwise rotation of the left side testicle), every rabbit was accepted surgery reset after 9 hours and found all twisted testicles were dark.After fomentation with warm salt water, all the testicles were observed no significant improvement in colors, and no fresh blood flow after opening tunica albuginea, then all the testicles were retained and fixed.Low molecular dextran(5 ml/kg, ear marginal vein injection, 1/d), papaverine(1.5 mg/kg, intramuscular, 3/d) and low molecular weight heparin sodium(200 IU/kg, subcutaneous, 1/d) were applied to promote testicular revascularization for 5 days in experimental group, and penicillin (40 000 U/kg, intramuscular, 1/d) for 7 days.Control group was only given penicillin(40 000 U/kg, intramuscular, 1/d) to prevent wound infection.Then Color Doppler ultrasound was used to observe the testicular blood flow siganals that were divided into 0, 1, 2, 3 classes.Class 2 and class 3 could be considered as testicular survival.After each scrotum was opened, according to color, texture of testicle and whether the fresh blood flowing out when tunica albuginea was opened, to determine whether the testicle was alive.The testicle was ruddy, flexible, and fresh blood was observed, which could prove testicular survival. Results In experimental group, the testicular blood flow siganals: 0 class 4 cases, 1 class 3 cases, 2 class 4 cases, 3 class 7 cases.In control group, the testicular blood flow siganals: 0 class 9 cases, 1 class 2 cases, 2 class 4 cases, 3 class 3 cases.Surgical exploration found 11 cases of testicular survival in experimental group and 7 cases in control group, which was significantly difference (P<0.05). Conclusions The combined application of low molecular dextran, papaverine, low molecular weight heparin sodium can promote the recovery of testicular blood after reduction of testicular torsion, and improve testicular survival rate. Key words: Testicular torsion; Low molecular dextran; Papaverine; Low molecular weight heparin sodium; Testicular survival

Laparoscopic Orchiopexy Requiring Vascular Division: A Randomized Study Comparing the Primary and Two-Stage Approaches.

Intraabdominal testes that lack sufficient vessel length to perform an orchiopexy require division of the testicular vessels. Historically, the vessels are divided at the initial operation, and the orchiopexy is then performed as a two-stage procedure with the assumption for the development of neovascularization along the vas deferens during the interim. Recent reports suggest the orchiopexy may be performed primarily at the time of vessel division. However, these strategies have not been prospectively compared. Therefore, we conducted a randomized pilot trial to examine the role for a larger comparative study. After Internal Review Board approval, all patients undergoing laparoscopic orchiopexy for a nonpalpable testis were considered for enrollment. This study was designed as a pilot study to evaluate testicular survival at 6 months of follow-up. After consent was obtained, computer randomization was used to determine a primary or two-stage orchiopexy. All procedures were performed by five surgeons, and allotment had no affect on surgeon selection. Between October 2007 and September 2013, 112 patients were enrolled in the study. Twenty-seven patients (14 primary and 13 two-stage) met criteria for randomization based on inability to bring the testis to the contralateral internal ring. There was no difference in the approach among surgeons. Mean operative time and cost significantly favored the primary approach, and testicular survival rates were the same. Based on the data in our pilot study, approximately 70% of patients with a nonpalpable testis will not require vascular division. This study suggests that when vascular division is required, the primary orchiopexy may be equivalent to the traditional two-stage procedure with regard to testicular survival and superior to the two stage in total operative time and charges. These data provide evidence for sufficient equipoise to proceed with the development of a large multi-institutional trial comparing these two approaches.

Mapping testicular blood supply in gubernaculum-sparing second-stage Fowler-Stephens procedure.

Testicular survival following second-stage Fowler-Stephens (FS) procedure depends upon adequate arterial supply. There is evidence that testicular survival rates are greater following gubernaculum-sparing second-stage FS procedure. The importance of collateral vessels in preservation of the testis has been hypothesised, but never shown in the literature. We aim to map the collateral blood supply to the testicle in gubernaculum-sparing, laparoscopic-assisted, second-stage FS procedure for intra-abdominal testicles. Selected patients undergoing a second-stage FS procedure were photographed prior to pexy in the Dartos pouch. Photographs were evaluated for the extent of vascular collateralisation between gubernacular, deferential and the ligated spermatic artery. Twenty-five patients with 28 undescended testicles underwent staged FS procedure over a 7.5-year period between 2005 and April 2013. Mean age at operation was 2.44 years, and all testicles were delivered to the scrotum. Mean follow-up was 3.29 years, and all patients were reviewed by the operating consultant. Testicular survival rate was 100 %. Representative photographs clearly demonstrate substantial cremasteric vessels running along the gubernaculum with robust collateralisation to the deferential vessel and the spermatic arterial stump. These images confirm the presence of robust collateral between the cremasteric and deferential vessels at second-stage FS procedure. Preservation of these collaterals in a gubernaculum-sparing approach may explain the excellent results seen in this series.

Laparoscopic Orchiopexy for a Nonpalpable Testis

PurposeWe evaluated the efficacy and the availability of laparoscopic orchiopexy to manage a nonpalpable intra-abdominal testis and studied outcomes including the testicular survival rate and associated complications.Materials and MethodsWe retrospectively reviewed the medical records of 67 children (86 testicular units) who underwent laparoscopic orchiopexy for a nonpalpable intra-abdominal testis between 1996 and 2008. The mean patient age was 2.4 years (median, 1 year; range, 0.5-9 years), and the mean follow-up period was 21.8 months (range, 0.3-138.4 months). Testicular viability and orchiopexed positioning were evaluated within 1 month and beyond 3 months.ResultsOf 86 testes, 69 testes were treated with primary laparoscopic orchiopexy (PLO) sparing the internal spermatic vessel, 14 testes were treated with one-stage Fowler-Stephens laparoscopic orchiopexy 1, and 3 testes were treated with two-stage Fowler-Stephens laparoscopic orchiopexy 2. The testicular survival rates were 97.7% (84/86) within 1 month and 93.7% (59/63) beyond 3 months. Of 59 viable testes followed up beyond 3 months, 48 (81.4%) testes were positioned in the lower scrotum and 11 (18.6%) testes in the mid to high scrotum.ConclusionsLaparoscopic orchiopexy was successful for a nonpalpable intra-abdominal testis with a high testicular survival rate irrespective of the location from the internal ring. However, atrophy of the testis or upward migration of the testis can occur during follow-up, so we suggest watchful, periodic follow-up evaluating the viability and location of orchiopexed testes that are located in the lower scrotum in the immediate postoperative period or during short-term follow-up.

Guideline for the Surgical Diagnosis and Treatment of Nonpalpable Testis Based on Experiences with Laparoscopic Procedure

Purpose: We assessed our laparoscopic experiences for the children with nonpalpable testis to evaluated the advantages of performing laparoscopy and we suggest a surgical management guideline for them. Materials and Methods: We retrospectively reviewed the medical records of a total of 83 children(97 testes) who underwent diagnostic laparoscopy for nonpalpable testes. We analyzed the surgical decisions and outcomes according to the laparoscopic findings. Results: On the laparoscopic examination, 48(49.5%) testes were located in the abdominal cavity. We subsequently performed inguinal orchiopexy (28), laparoscopic orchiopexy(8), Fowler-Stephens orchiopexy(10, one or two stage), or orchiectomy(2). The other 40(41.2%) were suspected to be testicular nubbin, and we managed this by excision of the testicular nubbin by the inguinal(29) or scrotal(10) approach, except for one viable testis in the inguinal canal. When blind-ending vessels were observed, we stopped the procedure under the diagnosis of vanishing testis in 9 cases(9.3%). The testicular survival rates were 92.6%(25/27) for inguinal orchiopexy, 100%(8/8) for laparoscopic orchiopexy and 60%(6/10) for Fowler-Stephen orchiopexy. Conclusions: We preferred laparoscopic orchiopexy for treating intraabdominal testis when the location was 2.5cm from the internal ring. When the testicular location was closer to the internal ring, we recommend inguinal orchiopexy as a viable option. In cases with high riding testis or very short internal spermatic vessels, we recommend Fowler-Stephens orchiopexy. For the suspected testicular nubbin, we preferred trans-scrotal excision when the nubbin was identified in the scrotum. Otherwise, we recommend inguinal exploration.